Moving Beyond Reflexive and Prophylactic Gynecologic Surgery

We strongly advocate using evidence to guide gynecologic surgery. We are now seeing the unintended consequences of assuming that the uterus and ovaries are only reproductive organs. Although women with high risk of future disease—such as those with BRCA1 and BRACA2 genetic variants—require prophylactic surgery, extending this practice to women at average risk of ovarian and fallopian tube cancer is not evidence based and exposes women not only to the risks of surgery but potentially also to increased long-term risk of somatic and mental diseases for which the average risk is already much higher than that of ovarian cancer. 18 The trend in medicine is clearly away from surgery. For breast cancer, we have evolved from the 19th-century model of radical surgery to the 21st-century view of minimal surgery for diagnosis and control of local disease. Similarly, with prostate cancer, surgery is being replaced by multiple modalities of less invasive interventional therapy and medications, including more precise disease stratification, tying disease aggression with treatment invasiveness. Let’s move forward in 21st-century gynecology to a “less-is-more” and “surgery-only-as-indicated” paradigm, as with other diseases.